Practical steps to improve chronic hepatitis C treatment in people with opioid use disorder

Abstract

Carlos Roncero,1 Pablo Ryan,2–4 Richard Littlewood,5 Juan Macías,6 Juan Ruiz,7 Pedro Seijo,8 Raúl Felipe Palma-Álvarez,9–11 Pablo Vega12,13 1Psychiatric Service, University of Salamanca Health Care Complex, Institute of Biomedicine of Salamanca, University of Salamanca, Salamanca, Spain; 2Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain; 3School of Medicine, Complutense University of Madrid, Madrid, Spain; 4Gregorio Marañón Health Research Institute, Madrid, Spain; 5applied strategic, London, UK; 6Department of Infectious Diseases and Microbiology, Valme University Hospital, Seville, Spain; 7Provincial Center of Drug Addiction, Malaga, Spain; 8Addiction Treatment Center of Villamartín, Cádiz, Spain; 9Addiction and Dual Diagnosis Unit, Vall Hebron University Hospital, Barcelona, Spain; 10Psychiatry Service, Biomedical Research Networking Center for Mental Health Network, Vall Hebron University Hospital, Barcelona, Spain; 11Autonomous University of Barcelona, Barcelona, Spain; 12Spanish Society of Dual Diagnosis, Bilbao, Spain; 13Institute of Addictions, Madrid, Spain Objectives: People with a history of injecting drugs have high prevalence of hepatitis C virus (HCV) infection, and many have opioid use disorder (OUD). Modern HCV therapies with improved efficacy and tolerability are available, but access is often limited for this group, who may be underserved for health care and face social inequity. This work develops practical steps to improve HCV care in this population. Methods: Practical steps to improve HCV care in OUD populations were developed based on clinical experience from Spain, structured assessment of published evidence. Results: Options for improving care at engagement/screening stages include patient education programs, strong provider–patient relationship, peer support, and adoption of rapid effective screening tools. To facilitate work up/treatment, start options include simplified work up process, integration of HCV and OUD care, and continuous psychosocial support prior, during, and after HCV treatment. Conclusion: It is important to plan on local basis to set up a joint integrated approach between specific drug treatment services and local points of HCV care. The elements for a specific integrated program should be chosen from options identified, including education services, peer input, organization to make HCV screening and treatment easier by co-location of services, and wider access to prescribing direct-acting antiviral (DAA) therapy. Keywords: HCV, opioid use disorder, treatment, elimination, practical recommendations

Keywords

• HCV
• Opioid Use Disorder
• Treatment